Prominent ears are largely something a person is born with; in some cases an ear also loses its shape after an injury. When the fold that should run through the upper part of the ear (the antihelix) does not develop, or when the bowl of the ear (the concha) is deep, the angle between the back of the ear and the skull widens and the ears stand out. Prominent ears do not cause a health problem; they are an ear shape that can bother people only because of how it looks. Even so, how other children react at school, or how people see themselves, can make them want to change how their ears sit.
Otoplasty aims to correct this shape in a single operation: the ear is approached from behind, the missing fold is created in the cartilage, and the ear is set at a closer angle to the head. The operation takes about an hour, and hearing is not expected to be affected.
Age and timing
The ear reaches most of its adult size by around 5 to 6 years of age; after that it keeps growing slowly, mainly in length, until about 11 or 12. Surgery is therefore not advised for children under 5; from the age of 6 it can be done at the family’s request, and there is no upper age limit for adults. In about the first six months of life, while the ear cartilage is still soft, an ear can sometimes be reshaped without surgery using special splints.
What is assessed at the consultation
Dr. Teker examines each ear separately: the angle between the ear and the head, how far the antihelical fold has developed, the depth of the bowl of the ear and the stiffness of the cartilage. In a typical ear this angle is no more than about 30 degrees; in a prominent ear it is clearly wider. Whether the cartilage is soft or stiff decides which technique is used to create the fold. With children, the decision is made together with the family, listening to the child’s own wishes too, and what the operation will and will not change is discussed openly.
How the operation works
The operation can be done under local or general anaesthesia; Dr. Teker prefers general anaesthesia for very young children, and local anaesthesia is also an option for older patients. The ear is approached from behind, through the crease where it joins the head; there is no incision on the front of the ear. The missing fold is created in the cartilage and held in place with non-absorbable stitches; where needed, the cartilage is thinned or a small piece is removed. When an ear has lost its shape after an injury, it can be rebuilt with cartilage taken from the patient’s own body. The skin is closed with dissolving stitches.
After the operation
The first dressing is opened the next day and a soft headband goes on. It is worn day and night for about a week to protect the new position of the ears, and it also helps to ease pain and to prevent bleeding and swelling. Wearing it at night for a few more weeks may be advised. The skin stitches dissolve on their own, so none need removing. The ears can be tender and feel numb for a few weeks. Most children are back at school within one to two weeks; contact sports resume at around eight weeks. The cartilage can take several months to become flexible again.